Research studies have repeatedly confirmed that MammaCare@ is an effective method of learning to perform a competent manual breast examination. The MammaCare Learning System advances tactile skills by training a woman to detect small simulated lesions in a lifelike breast model and transferring that skill to her breast tissue. Approximately 10 million blind and visually impaired women and deaf and hard-of-hearing women cannot access the requested visual or auditory training components of MammaCare. During the Phase I grant, a series of adaptive prototype systems were constructed and tested experimentally. The results indicate that the prototypes significantly improve breast-examination proficiency in the experimental groups of blind and visually impaired women and deaf and hard-of-hearing women. The Phase II proposal investigates the use of the adaptive prototypes by 1,000 women at home, 500 of whom are blind or visually impaired and 500 who are deaf or hard-of-hearing. The results will establish whether the experimental adaptive versions are sufficient to allow women with sensory impairments to successfully conduct breast self-examinations at home. If affirmed, the benefits of this potentially life-saving technology will become available to a substantial population of underserved women. PROPOSED COMMERCIAL APPLICATION: The proposed adaptive products for breast self-examination (BSE) have a large potential audience. There are approximately 10 million blind or deaf women in the United States who may be able to use the applicant's system as a result of this SBIR/PhaseII investigation